Implementation and effectiveness of transgender stigma reduction interventions in sub-Saharan Africa: a scoping review

Abstract

Background The transgender or trans population is one of the most marginalized social groups globally, frequently experiencing ill-treatment and discrimination. This is disproportionately higher in sub-Saharan Africa where trans people experience stigma even in healthcare settings. There is limited evidence concerning the implementation and outcomes of interventions to mitigate this stigma. Therefore, this scoping review aimed to describe interventions and determine their effectiveness in reducing transgender stigma in sub-Saharan Africa. Methods Searches (completed November 01, 2021, and re-run May 2022) were conducted in MEDLINE (via PubMed), Cochrane Library including the Cochrane Central Register of Controlled Trials, EBSCOhost, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Web of science, clinicaltrials.gov, and online grey literature sources to identify publications that described interventions to reduce transgender stigma in sub-Saharan Africa. Results From 877 literature search results, 23 full-text articles were assessed. Data were extracted from the four (4) eligible papers. Only one study explicitly mentioned transgender people. Second, while two studies incorporated conceptual frameworks, they did not show how the frameworks guided the study. The four studies implemented unique interventions at various socio-ecological levels to address individual and interpersonal and structural stigma. Each study utilized a different methodological approach, and the interventions were all evaluated qualitatively. Conclusions There is a paucity of transgender stigma reduction interventions implemented in Sub-Saharan Africa with limited evidence of interventions delivered to mitigate stigma at interpersonal and structural levels. Future anti-transgender stigma research should consider reporting details about the core components and descriptions of the interventions. Additionally, the use of validated measures of stigma and the evaluation of interventions for implementation outcomes would be helpful.

A qualitative description of HIV testing and healthcare experiences among trans women in Ghanaian urban slums BSGH-011

“…Within the sub-Saharan region of Africa, trans women continue to face severe societal stigmatization, reinforced by both cultural norms and legal structures [10][11][12][13] . Cultural norms in many sub-Saharan African societies often dictate rigid gender roles and expectations, leading to the marginalization of individuals whose gender identity do not conform to the dominant traditional norms [14][15][16][17] . Similar to other African nations, Ghana is deeply religious 18 , which correlates with widespread anti-LGBT sentiment 19 .…”

“…As a result, physical and violent homophobic attacks against LGBT individuals are frequent and often endorsed by the media, as well as religious and political Figs. 1 [4][5][6][7][8][9][10][11][12][13][14][15][16][17]21 .…”